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General NPI Number Information
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NPI Number | 1932700549
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Entity Type | Individual
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Provider Name | SYDNEY WILSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 100 EXECUTIVE PARK STE 103
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City | LOUISVILLE
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State | KY
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Zip | 40207-4201
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Country | US
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Telephone | 502-975-2960
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Fax |
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Provider Business Mailing Address
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Address Line | 380 SUWANNEE TRAIL ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7956
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Country | US
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Telephone | 270-901-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225C00000X
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Taxonomy Name | Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 259344
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License Number State | KY
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